RESEARCH FROM S.H. ARMENIAN AND CO-RESEARCHERS YIELDS NEW FINDINGS ON CONGESTIVE HEART FAILURE
Hematology Week
January 19, 2009
"To examine the independent roles of pre-hematopoietic cell
transplantation (HCT) therapeutic exposures, transplantation-related
conditioning, and comorbidities (pre- and post-HCT) in the development
of late congestive heart failure (CHF) after HCT. This was a nested
case-control design," scientists in the United States report (see
also Congestive Heart Failure).
"Individuals with late CHF (diagnosed >= 1 year after HCT) were
identified from a cohort of 2,938 1 + year survivors who underwent
transplantation at City of Hope National Medical Center, Duarte,
CA. This cohort formed the sampling frame for selecting controls
(without CHF) matched for age and year of HCT, donor source (allogeneic
v autologous), and length of follow-up. Sixty patients with late CHF
were identified; median age at HCT was 45.3 years (range, 16.6 to
68.6 years); median time to CHF was 3.0 years (range, 1.03 to 18.9
years); 68% received autologous HCT. Median ejection fraction was
36.9% (range, 15% to 53%). Compared with matched controls n = 166),
patients with late CHF received more cycles of pre- HCT chemotherapy
(8.6 v 4.9 cycles; P< .01), had greater body mass index at HCT (28.4
v 26.2 kg/m(2); P = .01), greater lifetime anthracycline exposure
(285.3 v 175.6 mg/m(2); P< .01), and were more likely to have multiple
chronic comorbidities (30.0% v 13.9%; P< .01). Multivariable analysis
revealed number of pre- HCT chemotherapy cycles (odds ratio OR]
= 1.2; P< .01), anthracycline dose >= 250 mg/m2 (OR = 3.2; P =
.05), and two or more chronic comorbidities (OR = 4.3; P = .01)
to be independently associated with late CHF. Pre-HCT exposure to
anthracyclines and presence of comorbidities are primarily responsible
for the risk associated with late CHF after HCT. Conditioning-related
therapeutic exposure does not contribute significantly to the risk,"
wrote S.H. Armenian and colleagues.
The researchers concluded: "These results form the basis for
identifying high-risk individuals for targeted surveillance, as
well as developing preventive strategies in the form of aggressive
management of comorbidities."
Armenian and colleagues published their study in the Journal
of Clinical Oncology (Late Congestive Heart Failure After
Hematopoietic Cell Transplantation. Journal of Clinical Oncology,
2008;26(34):5537-5543).
For more information, contact S. Bhatia, City Hope Cancer Center,
1500 E Duarte Rd., Duarte, CA 91010, USA.
Publisher contact information for the Journal of Clinical Oncology
is: American Society Clinical Oncology, 2318 Mill Road, Ste. 800,
Alexandria, VA 22314, USA.
From: Emil Lazarian | Ararat NewsPress
